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Crowns


Why Is a Dental Crown Needed?

A dental crown may be needed in the following situations:

  1. To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth

  2. To restore an already broken tooth or a tooth that has been severely worn down

  3. To cover and support a tooth with a large filling when there isn't a lot of tooth left

  4. To hold a dental bridge in place

  5. To cover misshapened or severely discolored teeth

  6. To cover a dental implant

  7. To make a cosmetic modification

For children, a crown may be used on primary (baby) teeth in order to:

  • Save a tooth that has been so damaged by decay that it can't support a filling.

  • Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene.

  • Decrease the frequency of sedation and general anesthesia for children unable because of age, behavior, or medical history to fully cooperate with the requirements of proper dental care.

In such cases, a pediatric dentist is likely to recommend a stainless steel crown.


What Types of Crowns Are Available?

Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal, all resin, or all ceramic.

  • Stainless steel crowns are prefabricated crowns that are used on permanent teeth primarily as a temporary measure. The crown protects the tooth or filling while a permanent crown is made from another material. For children, a stainless steel crown is commonly used to fit over a primary tooth that's been prepared to fit it. The crown covers the entire tooth and protects it from further decay. When the primary tooth comes out to make room for the permanent tooth, the crown comes out naturally with it. In general, stainless steel crowns are used for children's teeth because they don't require multiple dental visits to put in place and so are more cost- effective than custom-made crowns and prophylactic dental care needed to protect a tooth without a crown.

  • Metals used in crowns include gold alloy, other alloys, or a base-metal alloy. Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, metal crowns rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.

  • Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.

  • All-ceramic or all-porcelain dental crowns provide better natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.

  • Temporary versus permanent. Temporary crowns can be made in your dentist's office, whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by a lab.


What Steps Are Involved in Preparing a Tooth for a Crown?

Preparing a tooth for a crown usually requires two visits to the dentist -- the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.


How Should I Care for My Temporary Dental Crown?

Because temporary dental crowns are just that -- a temporary fix until a permanent crown is ready -- most dentists suggest that a few precautions. These include:

  • Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.

  • Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of the mouth.

  • Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.

  • Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.


What Problems Could Develop With a Dental Crown?

  • Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix the problem.

  • Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.

  • Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If a crown feels loose, contact your dentist's office.

  • Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit, a lack of cement, or a very small amount of tooth structure remaining that the crown can hold on to. If this happens, clean the crown and the front of the tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for the tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement the crown in place; if not, a new crown will need to be made.

  • Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.

  • Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.


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